Low-intensity cognitive-behaviour therapy interventions for obsessive-compulsive disorder compared to waiting list for therapist-led cognitive-behaviour therapy: 3-arm randomised controlled trial of clinical effectiveness

Background Obsessive-compulsive disorder (OCD) is prevalent and without adequate treatment usually follows a chronic course. “High-intensity” cognitive-behaviour therapy (CBT) from a specialist therapist is current “best practice.” However, access is difficult because of limited numbers of therapists and because of the disabling effects of OCD symptoms. There is a potential role for “low-intensity” interventions as part of a stepped care model. Low-intensity interventions (written or web-based materials with limited therapist support) can be provided remotely, which has the potential to increase access. However, current evidence concerning low-intensity interventions is insufficient. We aimed to determine the clinical effectiveness of 2 forms of low-intensity CBT prior to high-intensity CBT, in adults meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for OCD. Methods and findings This study was approved by the National Research Ethics Service Committee North West–Lancaster (reference number 11/NW/0276). All participants provided informed consent to take part in the trial. We conducted a 3-arm, multicentre randomised controlled trial in primary- and secondary-care United Kingdom mental health services. All patients were on a waiting list for therapist-led CBT (treatment as usual). Four hundred and seventy-three eligible patients were recruited and randomised. Patients had a median age of 33 years, and 60% were female. The majority were experiencing severe OCD. Patients received 1 of 2 low-intensity interventions: computerised CBT (cCBT; web-based CBT materials and limited telephone support) through “OCFighter” or guided self-help (written CBT materials with limited telephone or face-to-face support). Primary comparisons concerned OCD symptoms, measured using the Yale-Brown Obsessive Compulsive Scale–Observer-Rated (Y-BOCS-OR) at 3, 6, and 12 months. Secondary outcomes included health-related quality of life, depression, anxiety, and functioning. At 3 months, guided self-help demonstrated modest benefits over the waiting list in reducing OCD symptoms (adjusted mean difference = −1.91, 95% CI −3.27 to −0.55). These effects did not reach a prespecified level of “clinically significant benefit.” cCBT did not demonstrate significant benefit (adjusted mean difference = −0.71, 95% CI −2.12 to 0.70). At 12 months, neither guided self-help nor cCBT led to differences in OCD symptoms. Early access to low-intensity interventions led to significant reductions in uptake of high-intensity CBT over 12 months; 86% of the patients allocated to the waiting list for high-intensity CBT started treatment by the end of the trial, compared to 62% in supported cCBT and 57% in guided self-help. These reductions did not compromise longer-term patient outcomes. Data suggested small differences in satisfaction at 3 months, with patients more satisfied with guided self-help than supported cCBT. A significant issue in the interpretation of the results concerns the level of access to high-intensity CBT before the primary outcome assessment. Conclusions We have demonstrated that providing low-intensity interventions does not lead to clinically significant benefits but may reduce uptake of therapist-led CBT

Modeling of Technical Losses in theSenegalese Transmission andDistribution Grids and Determination ofNon-technical Losses

Electricity is a sector in crisis in Senegal. The main part of production and all the activities oftransmission and distribution of electricity are managed by the Senegalese National Society ofElectricity called SENELEC which is encountering enormous difficulties. One of the mostimportant problems is the fact that 21% of the produced energy is lost without being sold.This figure is enormous but quite typical with regards to African countries.Moreover, the distribution of these losses is insufficiently known. Only the production andtransmission losses can be determined from frequent and accurate measurements. Thedistribution losses represent the rest and constitute more than 80% of the losses. However, thedistribution between technical and non-technical losses (essentially due to fraud) is unknownin the distribution grid. In addition, the distribution of distribution technical losses betweenthe 30 kV, 6.6 kV and 400V grids is unknown. The goal of this Master’s Thesis is to estimatethese unknown losses. Moreover, some recommendations are suggested to reducetransmission and distribution losses.Regarding the transmission grid, Senelec does not take transmission losses into account in itsdispatching decisions, which increases transmission losses. After a Matlab modeling of thetransmission grid, a basic optimal dispatching program was developed to include losses and toprove that it would be better to consider losses in the dispatching decision.The study of the distribution grid constitutes the main part of this Master’s Thesis. Thedistribution grid can be divided in a medium-voltage grid (30 kV and 6.6 kV) and a lowvoltagegrid (400V). Losses in medium-voltage grid are estimated by the modeling of a partof this grid by using the software PSAF. Losses in low-voltage grid cannot be estimated thisway because of the lack of knowledge regarding the structure of this grid; thus, these lossesare estimated using a semi-empirical formula. Finally, non-technical distribution losses arededuced by calculating the difference between the total losses and the technical losses.The results show that the main part of the losses in Senegal are non-technical losses, whichrepresent 2/3 of the total losses and 40 billion of FCFA (61 million €), which is twice as highas what the company believed. High priority must be given to reduce them by an ambitiousplan against fraud. Technical losses even if they are smaller are not negligible and can also bereduced with some well-focused actions

A strain of Eurotium echinulatum Delacr. isolated from a vertisol

13 páginas, 2 figuras, 1 tabla, 29 referencias.[EN]: A strain of Eurotium echinulatum Delacr. has been isolated from a vertisol. It is a new record for Spain. Its morphological characteristics, as well as it physiology in several culture media with regard to the humic acid-like pigment formation are discussed.[ES]: Se ha aislado de un vertisuelo una estirpe de Eurotium echinulatum Delacr., cuyas características morfológicas son algo atípicas. Es una nueva cita para España. Se estudian también algunas de sus características fisiológicas en distintos medios de cultivo y su influencia en la formación de un pigmento de tipo húmico.Peer reviewe